Post-Endoscopic Retrograde Cholangiopancreatography Complications Management

Endoscopic retrograde cholangiopancreatography (ERCP) is a cornerstone intervention for diagnostic and therapeutic management of biliary and pancreatic disorders. Despite advances in endoscopic technique and peri-procedural care, post-ERCP complications remain a significant clinical challenge, with pancreatitis, haemorrhage, infection and perforation among the most common adverse events. Effective management requires a multifaceted approach encompassing careful patient selection, rigorous risk stratification, optimised procedural techniques and evidence-based prophylaxis. Identified patient-related risk factors include younger age, female sex, suspected sphincter of Oddi dysfunction and prior history of post-ERCP pancreatitis, while procedure-related factors encompass repeated cannulation attempts, pancreatic duct manipulation and precut sphincterotomy. Preventive strategies have evolved to incorporate rectal non-steroidal anti-inflammatory drugs (NSAIDs), aggressive periprocedural hydration and selective use of prophylactic pancreatic stents. Early recognition of complications through clinical monitoring, laboratory markers and imaging is essential to initiate prompt supportive care, including fluid resuscitation, antibiotics for cholangitis and endoscopic or surgical intervention for perforation or bleeding. Recent technological innovations, such as real-time pressure monitoring and computer-assisted cannulation guidance, hold promise for further reduction of adverse events. As global practice patterns diverge and resource availability varies, a tailored algorithm that integrates local expertise, patient risk profile and emerging evidence is paramount to improve outcomes and reduce healthcare burden.

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Post-Endoscopic Retrograde Cholangiopancreatography Complications Management publication trend

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Technical terms

Endoscopic retrograde cholangiopancreatography (ERCP): A combined endoscopic and fluoroscopic procedure to diagnose and treat biliary and pancreatic ductal disorders.

Post-ERCP pancreatitis (PEP): Acute inflammation of the pancreas occurring after ERCP, diagnosed by new abdominal pain and elevated pancreatic enzymes.

Pancreatic stent: A temporary plastic tube placed in the pancreatic duct to facilitate drainage and reduce the risk of ductal hypertension and pancreatitis.

Sphincter of Oddi dysfunction: Abnormal muscle contraction at the distal bile and pancreatic duct outlet that impedes flow and may predispose to pancreatitis.

Cholangitis: Inflammation and infection of the biliary tree, often presenting with fever, jaundice and right upper-quadrant pain.

Hyperamylasaemia: Elevated levels of the pancreatic enzyme amylase in the blood, indicative of pancreatic injury or inflammation.

References

1. Adverse Events Associated With Endoscopic Retrograde Cholangiopancreatography: Systematic Review and Meta-Analysis. Gastroenterology (2024).
2. Rectal indomethacin versus placebo to reduce the incidence of pancreatitis after endoscopic retrograde cholangiopancreatography: results of a controlled clinical trial. BMC Gastroenterology (2015).
3. Rectal indomethacin alone versus indomethacin and prophylactic pancreatic stent placement for preventing pancreatitis after ERCP: study protocol for a randomized controlled trial. Trials (2016).